皮肤嗜血分枝杆菌感染二例研究  

Cutaneous Mycobacterium haemophilum infection： two case reports

作　　者：陈浩[1] 符美华[1] 许昌春[1] 高薇[1] 张晓峰[1] 孙建方[1] 王洪生[1] 

机构地区：[1]中国医学科学院北京协和医学院皮肤病研究所,南京210004

出　　处：《中华皮肤科杂志》2015年第10期679-682,共4页Chinese Journal of Dermatology

基　　金：江苏省临床医学科技专项（BL2012003）;卫生部临床学科重点项目

摘　　要：目的提高对皮肤嗜血分枝杆菌感染的认识。方法报道2例皮肤嗜血分枝杆菌感染的临床表现、组织病理、病原学特点及治疗随访的情况。结果2例患者均存在免疫功能低下，皮损均发生在外伤后，临床最初均表现为界限清楚的皮下结节，逐渐出现破溃结痂和脓肿形成。组织病理显示真皮内上皮细胞肉芽肿形成或组织细胞浸润，伴有灶状坏死和中性粒细胞脓肿形成。抗酸染色可见大量的阳性杆菌。细菌仅能在含有铁离子的培养基中生长，病原体经PCR后测序符合嗜血分枝杆菌。根据药敏结果，给予患者利福平、克拉霉素和莫西沙星联合治疗后3个月，病情好转。结论嗜血分枝杆菌感染常发生于免疫抑制人群中，继发于外伤，表现为皮下结节和脓肿，组织学符合感染性肉芽肿改变，分子生物学是鉴定本病的可靠方法。Objective To improve the understanding of cutaneous Mycobacterium haemophilum infection. Methods Clinical and laboratory data were collected from two patients with cutaneous Myeohacterium haemophilum infection. The clinical and histopathologic manifestations, etiology and treatment of cutaneous Mycobacterium haemophilum infection were analyzed. Results The two patients were both immunocompromised. Lesions, which occurred after trauma in both the patients, began as well-marginated subcutaneous nodules, and then gradually progressed into ulceration with crusting and abscess formation. Histopathological examination revealed epithelial cell granuloma or histiocytic infiltrate in the dermis, as well as focal necrosis and neutrophil abscesses. Acid-fast staining showed abundant bacilli in tissues. These bacilli only grew in iron-containing medium, and were finally identified as Mycobacterium haemophilum by PCR and sequencing. According to the result of antimicrobial sensitivity testing, both the patients were treated with rifampicin, clarithromycin and moxifloxacin. Three months later, the condition was improved in both of them. Conclusions Mycobacterium haemophilum infection occurs most frequently in immunocompromised populations after trauma, manifests as subcutaneous nodules and abscesses with histopathological changes consistent with infectious granuloma. Molecular biological approaches are reliable for the identification of Mycobactenum haemophilum.

关 键 词：皮肤疾病 嗜血分枝杆菌 非结核分枝杆菌 免疫活性 肉芽肿 

分 类 号：R516[医药卫生—内科学]